Massachusetts PIP Insurer’s Payment of Disputed Bill

Boston Municipal Court’s Appellate Division recently decided a Massachusetts case that changes the way collection of outstanding bills from PIP will now be handled. Handling personal injury, auto and car accident and injury cases throughout the Boston area, the attorneys at the Law Office of Neil Burns make every effort to keep providers current regarding changes to the law affecting their billing and collection practices and considerations.

We previously blogged about this case whereas the ruling also concerned, and changed, the acceptable parameters of having bills reviewed for reasonable and customary charges within a provider’s geographical area. This case is notable because it also addressed the manner in which PIP insurers are able to dismiss claims for unpaid and/or disputed bills following a claim for the same.

PIP insurers, attorneys representing providers, and trial courts have long held that once the insurer pays the full amount of a disputed claim, the claim is extinguished. So, for example, if a provider files suit to recover an unpaid balance, if the insurer paid the disputed amount at any time before trial, then the claim was dismissed; the amount in controversy having been paid. Now, however, that no longer holds true.

The Court has held that ‘[n]othing in [our previous decision] dictates that a tender of the balance due under [a] §34M claim must necessarily stop that part of the litigation in its tracks.’ Metro West Med. Assocs. v. Amica Mut. Ins. Co., 2010 Mass. App. Div. 137, 139. And most recently, when a PIP insurer relied on the payment of the disputed amount requiring dismissal of the providers claim, the Court stated that “The mere payment of the balance, in and of itself, would not justify . . . judgment for [the insurer].”

The process, and outcome, of collecting unpaid PIP balances just got a lot more interesting, and potentially lucrative, for providers.

The case sited above is: Howard Physical Therapy, Inc. v. Premier Insurance Co. (Appellate Division, Northern District) (App. Div. No. 10-ADMS-10029) (Sept. 23, 2010).